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Gyn Onc > Prolog > Flashcards

Prolog Flashcards

1
Q

Possible cancers in Lynch II aka hereditary nonpolyposis colorectal cancer

A

Endometrium
Ovary
Gastric tract
Small bowel

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2
Q

Mismatch repair genes affected in lynch II aka HNPCC

A 
MLH1
MSH2
MSH6
PMS2
EPCAM
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3
Q

Lynch syndrome-associated endometrial cancer accounts for up to X% of all endometrial cancer

A

6%

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4
Q

germline TP53 mutations are associated with __ syndrome

A

Li–Fraumeni

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5
Q

Li-Fraumeni syndrome is associated with a high risk of what 5 kinds of cancer?

A 
soft tissue sarcomas
leukemia
adrenocortical cancer
breast cancer
brain cancer
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6
Q

Overexpression of PTEN is associated with __

A

Cowden disease

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7
Q

Heritability of Cowden disease

A

autosomal dominant

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8
Q

Cowden disease is associated with what 3 cancers & what skin lesion?

A

breast cancer
thyroid cancer
endometrial cancer
benign mucocutaneous lesions

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9
Q 
A 45-year-old woman is diagnosed with grade 2 endometrioid adenocarcinoma of the endometrium, and she undergoes hysterectomy, BSO, and LA. She has a family Hx that includes cancer of the breast, lung, and colon in first-degree relatives. The test that will best inform her of her risk of future cancer is immunohistochemical staining of tumor tissue for:
(A) MLH1, MSH2 overexpression 
(B) BRCA1 mutation
(C) progesterone receptor
(D) TP53 mutation
(E) PTEN mutation
A

(A) MLH1, MSH2 overexpression

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10
Q

lifetime risk of breast cancer for a woman who carries a BRCA1 or BRCA2 mutation

A

65–74%

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11
Q

lifetime risk of ovarian cancer for a woman with a BRCA1 mutation

A

39 – 46%

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12
Q

lifetime risk of ovarian cancer for a woman with a BRCA2 mutation

A

12 - 20%

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13
Q

Risk of what other malignancies in BRCA2?

A

prostate
pancreatic
melanoma

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14
Q

In BRCA, risk-reducing salpingo-oophorectomy decreases the risk of breast cancer by:

A

50%

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15
Q

In BRCA, Risk- reducing salpingo-oophorectomy decreases the risk of ovarian cancer by:

A

80 – 95%

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16
Q

For ovarian cancer in BRCA pts, Risk reduction after 5 years of use: X%

A

33% to 38%

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17
Q 
A 42-year-old woman, G2P2, in whom breast cancer was diagnosed at age 38 years, comes to your office for her annual well-woman visit. Her family history is significant for a mother who was diagnosed with ovarian cancer at age 68 years and a maternal aunt who developed a low- malignant-potential tumor of the ovary in her 20s. Her risk of having an inherited predisposition for ovarian cancer or breast cancer is:
(A) less than 1% 
(B) 1–10%
(C) 11–20%
(D) greater than 20%
A

(D) greater than 20%

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18
Q 
A 45-year-old woman, para 2, has been hospitalized with symptoms of diplopia, vertigo, and dizziness for the past 10 days. Three days ago, she had a contrast MRI scan of the head, which was negative for mass effect, lesions, and plaques. She has an elevated platelet count of 800,000/mm3. A body CT is negative except for a 6-cm complex lesion in the left ovary. Mammography was negative 1 month ago. On physical exam, you confirm the neurologic deficits. Analysis of serum and CSF samples show elevated anti-Yo antibody levels. The best explanation for these findings is:
(A) hemorrhagic stroke
(B) embolic stroke
(C) paraneoplastic syndrome
(D) multiple sclerosis
A

(C) paraneoplastic syndrome

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19
Q

Anti-Y o progressive cerebellar degeneration most commonly is associated with:

A

ovarian or breast carcinoma

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20
Q

Elevated platelet count is often another paraneoplastic manifestation of ovarian cancer resulting from:

A

increased production of thrombopoietic cytokines in the tumor and host tissue

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21
Q

A 42 yo Asian woman w/ a history of molar pregnancy comes to your office 13 months after initial diagnosis. Her serum β-hCG level is 14,650 IU/L. You diagnose gestational trophoblastic neoplasia (GTN). Her exam shows a 1-cm vaginal lesion. Pelvic US shows a 4-cm intrauterine tumor. Chest, abdomen, and pelvic computed CT scans show a 2-cm lung lesion consistent with metastatic disease. Head MRI is negative for metastasis. Her age, β-hCG level, 4-cm intrauterine tumor, and total of 2 metastatic sites give her a modified WHO risk score of 5. The factor that increases her WHO score to 9 is:

(A) previous molar pregnancy
(B) interval from molar pregnancy to GTN diagnosis longer than 12 months
(C) vaginal metastasis on exam
(D) lung metastasis

A

(B) interval from molar pregnancy to GTN diagnosis

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22
Q

Treatment for GTN: stage I disease and low-risk (score less than 7) stage II and III disease

A

single-agent chemotherapy with either methotrexate or actinomycin D

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23
Q

Treatment for high-risk GTN disease: either stage IV disease or high-risk (score 7 or more) stage II and III disease,

A

multiagent chemo with or without site- directed surgery or radiotherapy
(1) Etoposide + methotrexate + actinomycin D + cyclophosphamide + vincristine (2) methotrexate + actinomycin D + cyclophosphamide

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24
Q

cyclophosphamide MOA

A

alkylating agent – prevents cell division by cross-linking DNA strands and decreasing DNA synthesis

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25
Q

cyclophosphamide adverse effect

A

hemorrhagic cystitis

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26
Q

bleomycin MOA

A

inhibits synthesis of DNA; binds to DNA leading to single and double strand breaks

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27
Q

bleomycin adverse effect

A

pulmonary fibrosis

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28
Q

doxorubicin MOA

A

inhibits topoisomerase II – inhibition of DNA and RNA synthesis, inhibition of DNA repair

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29
Q

doxorubicin adverse effect

A

cardiotoxicity

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30
Q

vincristine MOA

A

inhibits microtubule assembly - arrests cell at metaphase by disrupting formation of mitotic spindle (M & S phases)

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31
Q

vicristine adverse effect

A

neurotoxicity

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32
Q

carboplatinum MOA

A

alkylating agent - covalently binds to DNA, interstrand DNA cross-links; not cell-cycle specific

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33
Q

carboplatinum adverse reaction

A

thrombocytopenia

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34
Q

cisplatinum (cisplatin) MOA

A

inhibits DNA synthesis by formation of DNA cross-links, denatures double helix, covalently binds DNA

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35
Q

cisplatin adverse reaction

A

nephrotoxicity, neurotoxicity, ototoxicity, emetogenic

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36
Q

paclitaxel (Taxol) MOA

A

inhibits microtubule disassembly, interfering with late G2 mitotic phase

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37
Q

paclitaxel (Taxol) adverse reaction

A

Alopecia, immediate hypersensitivity, neutropenia, bradycardia

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38
Q

methotrexate MOA

A

folate antimetabolite that inhibits DNA synthesis, repair, and cellular replication - inhibits dihydrofolate reductase - cell cycle specific for S phase

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39
Q

methotrexate adverse reaction

A

Neutropenia, mucositis, nephrotoxicity

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40
Q

5 fluorouracil MOA

A

pyrimidine analog antimetabolite that interferes with DNA and RNA synthesis - inhibits thymidylate synthetase

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41
Q

5 fluorouracil adverse reaction

A

Neutropenia, mucositis, diarrhea, dermatitis

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42
Q

topotecan

A

inhibits topoisomerase I - stabilizes the cleavable complex so that religation of cleaved DNA strand cannot occur - S phase of cell cycle

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43
Q

topotecan adverse reaction

A

profound neutopenia

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44
Q

cycle nonspecific alkylating agents

A

cyclophosphamide
chlorambucil
platinum compounds

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45
Q

2 plant alkaloids

A

vincristine

vinblastine

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46
Q

plant alkaloids are __ phase specific

A

M phase

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47
Q

methotrexate is __ phase specific

A

S phase

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48
Q

chemo drug from the pacific Yew tree

A

Taxol

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49
Q

Taxol is __ phase speicific

A

M phase

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50
Q

antidose to ifosfamide

A

mesna

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51
Q

BRCA1 on chromosome __

A

17

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52
Q

BRCA2 on chromosome __

A

13

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53
Q

heritability of BRCA mutations

A

autosomal dominant

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54
Q

p53 & Rb are examples of __ genes

A

tumor suppressor

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55
Q

ras, HER-2/neu are examples are __ genes

A

oncogenes

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56
Q

What is the most common tumor in the broad ligament?

A

leiomyoma

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57
Q

metastatic tumore from stomach to ovary

A

Krukenburg tumors

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58
Q

cells found in Krukenburg tumors

A

signet ring cells

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59
Q

dermoid with mostly thyroid tissue, benign

A

struma ovarii

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60
Q

hydrops tubae profluens is a classic sign of :

A

fallopian tube carcinoma

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61
Q

optimal treatment of dermoid cyst

A

cystectomy with only inspection of contralateral ovary

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62
Q

treatment for endometrial hyperplasia

A

TAH vs progestin therapy (any progestin will do); premalignant potential directly related to degree of cellular atypia and to a far less extent the degree of architectural complexity; microscopically has crowded glands but no invasion

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63
Q

the action of lasers is based on __

A

Water (cells heat and explode)

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64
Q

most common tumor to metastasize to fetus

A

melanoma

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65
Q

What is luteoma of pregnancy

A

solid, benign tumor requiring no treatment; regresses after pregnancy

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66
Q

What is Meig’s syndrome

A

triad of ovarian fibroma, hydrothorax, ascites

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67
Q

most common sites of ureteral injury

A

at cardinal ligaments and infundibulopelvic ligaments

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68
Q

lymphatic drainage of vulva

A

inguinal

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69
Q

lymphatic drainage of lower part of vagina

A

inguinal

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70
Q

lymphatic drainage of upper vagina

A

iliac (pelvic)

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71
Q

lymphatic drainage of cervix

A

iliac (pelvic)

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72
Q

lymphatic drainage of uterus

A

iliac and paraaortic

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73
Q

acetic acid MOA

A

dehydrate cells

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74
Q

Lugol’s iodine MOA

A

glycogen stain; negative stain

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75
Q

after transection the broad ligament, the ureter is where?

A

on medial leaf

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76
Q

When doing omentectomy must ligate the __ arteries

A

gastroepiploic arteries

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77
Q

What are the steps of the cell cycle?

A

G1 - S (DNA replication) - G2 - M (mitosis)

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78
Q

attributes of plain and chromic catgut

A

intense inflammation, absorbed quickly by phagocytosis

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79
Q

attributes of Vicryl and Dexon

A

polyfilament, absorbed by hydrolysis

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80
Q

attributes of PDS & Maxon

A

monofilament, highest tensile strength for absorbables

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81
Q

attributes of Nylon & Prolene

A

monofilament, highest tensile strength of all sutures, nonabsorbable

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82
Q

cause of dyspereunia after radiation is usually:

A

atrophic vaginitis

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83
Q

Most important prognostic factor for endometrial, cervical, vulvar and breast cancer is:

A

node status

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84
Q

Main difference between tamoxifen and raloxifene is:

A

effect on endometrium (tamoxifen is proliferative)

85
Q

Most likely histologies of vulvar cancer

A
  1. Squamous cell cancer most common (~85% of all vulvar cancers)
  2. melanoma (~9%)
  3. Basal Cell Carcinoma (2%)
  4. Paget’s disease, Bartholin’s adenocarcinoma, sarcomas, and neuroendocrine tumors all rare
86
Q

Are chorionic villi found in molar pregnancy?

A

No

87
Q

Tx for stage IB1 cervical cancer, lesion 2cm or less, in patient desiring fertility

A

radical trachelectomy with pelvic lymphadenectomy

abdominal cerclage

88
Q

genetic inheritance of Lynch

A

autosomal dominant

89
Q

When should screening start in Lynch

A

age 25-30 years, or 10 years before known familial cancer

90
Q

What should screening consist of for Lynch?

A

q1-2 year colonoscopy, endoscopy
?annually TVUS and endometrial biopsy
Ca125 annually age 30-35
consider risk reducing surgery

91
Q

What 3 elements in a molar pregnancy make GTN 40% likely?

A

beta HCG >100,000
uterine size greater than dates
theca lutein cyst >6cm

92
Q

Schiller Duval bodies on histology

A

endodermal sinus tumor

93
Q

endodermal sinus tumor secretes __

A

AFP

94
Q

Women with a 5 year predicted risk of > __% for breast cancer are candidate for tamoxifen chemoprevention

A

1.66%

95
Q

tamoxifen demonstrated a __% decreased risk reduction in breast cancer in high risk premenopausal and menopausal women

A

49%

96
Q

side effects of tamoxifen

A

leg cramping, vasomotor symptoms

97
Q

treatment for late onset multidrug resistant pneumonia

A

antipseudomonal fluoroquinolone
beta lactam inhibitor
anti-MRSA

98
Q

greatest risk factor for development of ovarian cancer in patient without family history

A

nulliparity

99
Q

BRCA1 ovarian cancer risk

A

39-46%

100
Q

BRCA2 ovarian cancer risk

A

12-20%

101
Q

80% of mucinous tumors are __, characterized by __

A

mucinous cystadenoma

tall columnar epithelium and mucin containing cytoplasm

102
Q

3 indications for MRI screening of breast cancer

A

> 20% lifetime risk (genetically predisposed, history of mantle radiation for Hodgkins)
screen of contralateral breast in breast cancer
screen pts with breast implants

103
Q

What is in cryoprecipitate

A

fibrinogen, factor XIII, von willebrand factor

104
Q

What blood transfusion product has the most fibrinogen?

A

cryoprecipitate

105
Q

follow up for microinvasive cervical cancer with negative margins on LEEP

A

repeat Pap in 3-6 months for 2 years, then twice per year for 5 years

106
Q

Lymph node metastasis in endometrial cancer occurs in __% of well staged cases

A

10%

107
Q

chemo choice for uterine carcinosarcoma

A

carboplatin and paclitaxol

108
Q

optimal debulking in cytoreductive surgery is defined as when each visible tumor implant is < __

A

1 cm

109
Q

treatment of adenocarcinoma in situ of cervix

A

cone is sufficient if margins are not involved

110
Q

What tumor is characterized by absence of chorionic villi withh proliferation of intermediate trophoblasts

A

placental site trophoblastic tumor

111
Q

What tumor is characterized by neoplastic syncytiotrophoblast and cytotrophoblast without chorionic villi?

A

choriocarcinoma

112
Q

Complete mole has __% risk of persistence after evacuation

A

15%

113
Q

treatment for ductal carcinoma in situ with negative margins

A

radiation

114
Q

treatment for ductal carcinoma in situ in older patients with comorbidities

A

lumpectomy alone, or with tamoxifen (not radiation)

115
Q

treatment for multifocal DCIS

A

simple mastectomy

116
Q

treatment for incisional hernia >4cm

A

mesh

117
Q

treatment for incisional hernia 1cm at port site

A

primary closure

118
Q

treatment for incisional hernia 2x2 cm at umbilicus

A

primary closure

119
Q

treatment for incisional hernia >8cm discovered incidentally

A

nothing, low risk for incarceration, high risk of recurrence

120
Q

Risk of having an inherited predisposition to breast ca and ovarian ca: personal history of breast cancer
and ovarian cancer

A

> 20%

121
Q

Risk of having an inherited predisposition to breast ca and ovarian ca: Women with ovarian cancer and a close
relative with ovarian cancer, premenopausal
breast cancer, or both

A

> 20%

122
Q

Risk of having an inherited predisposition to breast ca and ovarian ca: Women with ovarian cancer who are of
Ashkenazi Jewish ancestry

A

> 20%

123
Q

Risk of having an inherited predisposition to breast ca and ovarian ca: Women with breast cancer at 50 years or younger and a close relative with ovarian
cancer or male breast cancer at any age

A

> 20%

124
Q

Risk of having an inherited predisposition to breast ca and ovarian ca: Women of Ashkenazi Jewish ancestry in whom breast cancer was diagnosed at age 40 years
or younger

A

> 20%

125
Q

Risk of having an inherited predisposition to breast ca and ovarian ca: Women with a close relative with a known BRCA1 or BRCA2 mutation

A

> 20%

126
Q

Risk of having an inherited predisposition to breast ca and ovarian ca: Women with breast cancer at age 40 years or younger

A

5–10%

127
Q

Risk of having an inherited predisposition to breast ca and ovarian ca: Women with ovarian cancer, primary peritoneal cancer, or fallopian tube cancer of high grade, serous histology at any age

A

5–10%

128
Q

Risk of having an inherited predisposition to breast ca and ovarian ca: Women with bilateral breast cancer (particu- larly if the first case of breast cancer was diag- nosed at age 50 years or younger)

A

5–10%

129
Q

Risk of having an inherited predisposition to breast ca and ovarian ca: Women with breast cancer at age 50 years or younger and a close relative with breast cancer at age 50 years or younger

A

5–10%

130
Q

Risk of having an inherited predisposition to breast ca and ovarian ca: Women of Ashkenazi Jewish ancestry with breast cancer at age 50 years or younger

A

5–10%

131
Q

Risk of having an inherited predisposition to breast ca and ovarian ca: Women with breast cancer at any age and two or more close relatives† with breast cancer
at any age (particularly if at least one case of breast cancer was diagnosed at age 50 years or younger)

A

5–10%

132
Q

neurologic symptoms of cerebellar degeneration, ovarian mass, normal head MRI

A

paraneoplastic syndrome - Anti-Y o progressive cerebellar degeneration - causes direct toxicity to Purkinje cells,

133
Q

heart sound in gas embolism

A

mill- wheel murmur

134
Q

treatment of gas embolism in lsc surgery

A

Release of the pneumoperitoneum
steeper Trendelenburg position
turned to the left side (Durant position) to further prevent flow of the gas into the pulmonary circulation

135
Q

What should you do when you get Pap with atypical glandular cells?

A

Colpo with endocervical sampling

136
Q

Historically, __ has been considered one of the most active (chemo) regimens in the treatment of carcinosarcoma.

A

ifosfamide–cisplatin

137
Q

Surgery confirms that she has gelatinous ascites and bilateral ovarian masses. Final pathology identifies pseudomyxoma peritonei. The most likely primary site is the

A

appendix

138
Q

Primary tumor? ytokeratin 7 (KRT7 or CK7), PAX8, and WT1

A

ovarian

139
Q

Primary tumor? cytokeratin 20 (KRT20 or CK20),

CEA, and CDX2

A

gastrointestinal

140
Q

grade 1 immature teratoma in her left ovary; management after surgery?

A

surveillance (patients with stage IA grade 1 immature teratoma have 5-year survival rates higher than 90% with no clear evidence to suggest that additional chemotherapy improves the outcome)

141
Q

s/p myomectomy pathology report characterizes the problem as “smooth muscle tumor of uncertain malignant potential.” The next best step in her management is

A

surveillance

142
Q

2 meds for prevention of chemotherapy-associated emesis

A

dexamethasone, selective type three 5-hydroxytryptamine (5-HT3) receptor antagonist (ondansetron)

143
Q

Final pathology shows a stage IA grade 1 endometrioid adenocarcinoma. Recommended 3–6 months follow-up surveillance is

A

pelvic examination; 85% of recurrent disease occurs at the vaginal cuff and most women present with vaginal bleeding

144
Q

treatment for cervical cancer, stage IA2 lesion

A

modified radical hysterectomy with concomitant pelvic lymph node dissection

145
Q

cervical cancer Stage IA1

A

tumor with stromal invasion, less than a 7-mm horizontal spread, and less than 3 mm in depth

146
Q

cervical cancer Stage IA2

A

tumor with stromal invasion, less than a 7-mm horizontal spread, and 3–5 mm in depth

147
Q

cervical cancer Stage IB1

A

a grossly visible tumor confined to the cervix and less than 4 cm or a microscopic lesion with dimensions greater than a stage IA tumor

148
Q

official CA 125 level that meets criteria for Gyn Onc referral for premenopausal

A

200

149
Q

management of 60yo, EMB with complex atypical hyperplasia

A

hysterectomy plus bilateral salpingo-oophorectomy

150
Q

A 31-year-old woman comes to your office with a 9-cm right ovarian mass. Surgical resection with laparoscopic oophorectomy is performed. The final pathologic findings show a granulosa cell tumor confined to the ovary without surface involvement. Pelvic washings are negative for malignant cells. The best next step in management is

A

endometrial sampling; Endometrial hyperplasia is observed in approximately 25–50% of patients with granulosa cell tumors of the ovary.

151
Q

name 4 Sex cord–stromal tumors

A

granulosa cell tumors
fibromas
thecomas
Sertoli–Leydig cell tumors

152
Q

the likelihood of developing a subsequent primary peritoneal carcinoma in patients with a BRCA mutation

A

4.5%

153
Q

The lesion associated with a p53 mutation that is found incidentally in salpingectomy specimens is

A

Serous tubal intraepithelial carcinomas

154
Q

precursor lesion in the distal fallopian tube that can lead to extra-uterine (pelvic) high-grade serous carcinomas

A

STIC (Serous tubal intraepithelial carcinomas)

155
Q

A woman with a BRCA2 mutation is scheduled to undergo a risk reducing bilateral salpingoophorectomy. To maximize the reduction of this patient’s risk of ovarian cancer, the procedure should include

A

Ligation of the ovarian vessels 2cm proximal to identifiable ovarian tissue

156
Q

In evaluating fallopian tubes for carcinoma in women undergoing risk-reducing surgery, what is the most important portion of the fallopian tube to be evaluated?

A

Fimbriae

157
Q

Example of HER2-directed treatment

A

Trastuzumab

158
Q

A 37-year-old gravida 2 para 2 is diagnosed with triple-negative breast cancer with a tumor size of 1.5cm and positive lymph nodes. Adjuvant chemotherapy is recommended, and the potential side effects are reviewed. The chemotherapy agent which carries the highest risk for ovarian toxicity is

A

cyclophosphamide

159
Q

A patient returns for follow up one year after her initial diagnosis of early breast cancer treated with Tamoxifen. She reports vasomotor symptoms and is interested in non-pharmacological options. The next best step in the management of this patient’s symptoms is

A

Relaxation therapy

160
Q

treatment for febrile neutropenia in low risk pt

A

outpatient for low risk; ciprofloxacin and amoxicillin–clavulanic acid

161
Q

Endometrial biopsy reveals a uterine papillary serous carcinoma. In contrast to endometrioid adenocarcinoma of the endometrium, the factor with which uterine papillary serous carcinoma is associated is

A

TP53 mutations

162
Q

What type of pathology does Type I endometrial cancer include?

A

endometrioid endometrial cancer

163
Q

What type of pathology does Type II endometrial cancer include?

A

poorly differentiated endometrioid adenocarcinomas
clear cell types
serous cell types

164
Q

Type I or Type II endometrial cancer? younger patients

A

type I

165
Q

Type I or Type II endometrial cancer? associated with obesity, hyperlipidemia, and hyperestrogenism

A

type I

166
Q

Type I or Type II endometrial cancer? ER/PR positive

A

type I

167
Q

Type I or Type II endometrial cancer? 90% with TP53 mutations

A

type II

168
Q

Type I or Type II endometrial cancer? 80% PTEN mutation

A

type I

169
Q

Type I or Type II endometrial cancer? more likely to present with metastatic disease at original diagnosis

A

type II

170
Q

A 54-year-old woman with breast cancer has completed 5 years of chemotherapy with tamoxifen citrate. Her medical oncologist has suggested that she use an aromatase inhibitor (AI) instead. The most likely adverse effect that she will experience if she makes the switch from tamoxifen to an AI is

A

joint aches

171
Q

In patients with advanced ovarian cancer that has been suboptimally cytoreduced, the current standard treatment is adjuvant __ after surgery

A

IV carboplatin and paclitaxel

172
Q

The outcome associated with preoperative mechanical bowel preparation is

A

trick questions, no improvement

173
Q

The criteria for a vaginal radical trachelectomy and pelvic lymphadenectomy for cervical cancer (5)

A
  • Desire for fertility
  • Reproductive age, typically younger than 40 years
  • Lesion size 2 cm or less with no extension to upper endocervix
  • Stage IA with lymphovascular invasion, stage IA2, or stage IB1
  • No evidence of nodal metastasis
174
Q

The three most common malignant germ cell tumors

A

dysgerminoma
endodermal sinus tumor
immature teratoma

175
Q

treatment for placental-site trophoblastic tumor

A

total hysterectomy; 10% of such tumors extend into the cervix and 50% are invasive into the outer one third of the myometrium

176
Q

CREOG def of severe C diff

A

WBC >15, Cr >1.5 times baseline

177
Q

CREOG treatment for mild/moderate C diff

A

PO flagyl

178
Q

CREOG treatment for severe C diff

A

PO vancomycin

179
Q

PE, patient develops HIT, what anticoagulation should you switch to?

A

argatroban (direct thrombin inhibitor) [similar to bivalirudin]

180
Q

The current standard of care for stage II–IV LGSC (low-grade serous ovarian cancer) is

A

surgical cytoreduction followed by platinum– taxane-based chemotherapy

181
Q

Compared with serous carcinoma of the ovary, the factor with which clear cell carcinoma of the ovary is more commonly associated is

A

endometriosis

182
Q

next step for 25yo with CIN 2

A

observation with repeat colposcopy and cytology at 6-month intervals for 12 months

183
Q

A 57-year-old woman is treated with cisplatin-based chemoradiotherapy for stage IIB cervical adenocarcinoma. Thirteen months after completion of radiotherapy, she has a central pelvic recurrence and undergoes total pelvic exenteration. Final pathology shows two positive pelvic lymph nodes, negative surgical margins, and a poorly differentiated adenocarcinoma. The prognostic factor that most consistently predicts poor outcome in this patient is

A

time to recurrence

184
Q

A 73-year-old woman comes to your office with a prolonged history of vulvar pruritus and burning. On examination, the vulva and perineum have a red, velvety, inflamed appearance. An office biopsy is performed, revealing large cells with prominent nuclei and coarse chromatin. Diagnosis?

A

extramammary Paget disease

do Cervical cancer screening, colonoscopy, and mammography to looking for coexisting malignancies

185
Q

After comprehensive surgical staging, a 65-year-old woman is diagnosed with stage IB uterine papillary serous carcinoma. The next step in management is

A

carboplatin–paclitaxel

186
Q

A 35-year-old woman palpates a 1-cm solid breast mass. A needle biopsy is carried out and con- firms an invasive ductal carcinoma. The best treatment for this patient is

A

lumpectomy with sentinel lymph node biopsy

187
Q

Cervical cancer: concurrent chemotherapy and radiation therapy should be used for: (3)

A
  • early-stage disease and bulky cervical tumors (greater than 4 cm)
  • high-risk factors after radical surgery, such as posi- tive lymph nodes and margins as well as parametrial extension
  • stage IIB–IVA locally advanced cervical cancer
188
Q

A 49-year-old woman undergoes a radical hysterectomy, BSO and bilateral pelvic lymph node dissection for stage IB1 cervical cancer. Final pathology shows a small cell carcinoma of the cervix. All resection margins and lymph nodes are negative for tumor. The next step in management is

A

chemotherapy

189
Q

The U.S. Public Health Service-preferred regimen for postexposure prophylaxis for occupational exposures to HIV

A

emtricitabine, tenofovir, raltegravir

190
Q

Complete mole, now s/p D&C. In terms of contraception, the most appropriate, evidence-based treatment recommendation for the next 6 months is

A

oral contraceptives

191
Q

Only variable in GOG 172 with correlation w IP catheter complication

A

left colon–rectosigmoid resection

192
Q

Treatment for DCIS in patient who doesn’t want surgery

A

radiation therapy

193
Q

A 50-year-old woman is taken to the operating room for laparoscopic management of a 5-cm complex right adnexal mass. Pelvic washings are collected before beginning the procedure and a laparoscopic RSO is performed. During the dissection of the broad ligament, the ovary is ruptured with leakage of a small amount of clear fluid. The frozen section returns as high-grade papillary serous carcinoma grade 3; the remainder of the staging surgery is then performed. The final pathologic report shows that all surgical specimens, including the pelvic washings, are negative. In regard to use of chemotherapy or radiation therapy, the most appropriate management is

A

intravenous chemotherapy because of the high-grade histology

194
Q

the strongest scientific evidence for the benefit of acupuncture in cancer patients is for

A

emesis

195
Q

A 27-year-old woman, gravida 1, para 0, with an intrauterine pregnancy at 12 weeks of gestation comes to your office for routine prenatal evaluation. Cervical cytologic screening reveals a low- grade squamous intraepithelial lesion. Colposcopy indicates cervical intraepithelial neoplasia 1 (CIN 1). The most appropriate next step in management is

A

reassessment postpartum

196
Q

A 54-year-old woman comes to your office with increasing pelvic pain. On examination, she has a small uterus, a small right ovary, and a left ovary that is enlarged to 6 cm and is mobile. Pelvic ultrasonography confirms a 6-cm complex adnexal mass. Her CA 125 level is 45 international units/mL. The patient undergoes a laparoscopic left salpingo-oophorectomy and pelvic washings, and the frozen section reveals a grade 2 serous adenocarcinoma of the ovary. The remainder of the abdomen and pelvis are normal. The most appropriate immediate management for this patient is

A

hysterectomy, contralateral salpingo-oophorectomy, omentectomy, lymphadenectomy, peritoneal washings, peritoneal biopsies

197
Q

What is most beneficial in decreasing risk of postoperative ileus

A

early postoperative feeding

198
Q

A 31-year-old woman comes to your office with vaginal bleeding. On examination, she is found to have a friable cervical mass, extension to the pelvic sidewalls, and a palpable supraclavicular lymph node. Biopsies of the cervix and lymph node confirm the presence of squamous cell car- cinoma. A PET-CT scan is performed and reveals extensive hypermetabolic pelvic disease, para-aortic lymphadenopathy, multiple lung lesions, and a supraclavicular node. She wishes to pursue treatment. You advise her that her best management option is

A

chemotherapy

199
Q

How to diagnose postmolar gestational trophoblastic disease (3 options)

A
  • β-hCG level plateau of four values plus or minus 10% recorded over 3 weeks
  • β-hCG level increase of more than 10% over three values recorded over 2 weeks
  • persistence of detectable β-hCG levels more than 6 months after evacuation
200
Q

The adverse effect of tamoxifen that she is most likely to experience is

A

hot flushes

201
Q

A 27-year-old nulligravid woman had a screening Pap test which showed atypical glandular cells. Follow-up colposcopy and biopsies with endocervical curettage indicated at least adenocarcinoma in situ. Final pathology from a cold conization showed an invasive adenocarcinoma with a diameter of 5 mm and depth of invasion of 2 mm, negative margins, and no lymphovascular space invasion. The best next step in management is

A

stage IA1. routine cervical cancer surveillance examinations (young age. otherwise simple extrafascial hysterectomy)

202
Q

A 9-year-old girl has a complex adnexal mass and precocious puberty. The tumor marker most likely to assist in your preoperative evaluation is

A

inhibin B level

common presentation for a juvenile-type granulosa cell tumor

203
Q

most likely trophoblastic disease subtype: Risk of persistence after dilation and evacuation is approximately 20%

A

Complete mole

204
Q

most likely trophoblastic disease subtype: Fetal vessels often are seen on hematoxylin and eosin stain

A

Partial mole

205
Q

most likely trophoblastic disease subtype: Systemic metastases occur frequently

A

Gestational choriocarcinoma

206
Q

most likely trophoblastic disease subtype: Histology characterized by proliferation of intermediate trophoblastic cells

A

Placental-site trophoblastic tumor

207
Q

What hemostatic agent? Acidic plant-based extract that saturates with blood at the bleeding site and forms a brownish or black gelatinous mass, which aids in the formation of a clot via the intrinsic coagulation pathway

A

oxidized regenerated cellulose (Surgicel)

208
Q

What hemostatic agent? Purified bovine-based agent that attracts platelets to a bleeding site, initiating the formation of a physiologic platelet plug

A

microfibrillar collagen

209
Q

What hemostatic agent? Bovine- or human-extracted agent that converts fibrinogen to fibrin in addition to cross- linked granules that aid in platelet adhesion and aggregation

A

flowable gelatin matrix with thrombin (Gelfoam)

Gyn Onc (2 decks)

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